Youth Suicide Prevention Flashcards
Assessing Level of Risk:
Moderate Risk
“Characteristics of youth at moderate risk for suicide:
A) These youth report frequent suicidal ideation with limited intensity and duration.
B) They may report some specific plans to kill themselves but report no intent.
C) Moderate risk youth will demonstrate good self-control, some risk factors, and be able to identify reasons for living and other protective factors.
What to do: Same as low-risk ((A) Notify parents., B) Create a safety plan with youth and parents (unless parents are a trigger for suicide risk)., C) Identify school-based supports for youth.))
In school:
A) Increase frequency and duration of visits with the SMHP or another school staff member who has been identified as an accepting, non-judgmental adult with whom the student feels safe and comfortable.
B) Reevaluate for suicide risk at every meeting and identify if youth is moving into low-risk or high-risk category.
C) Keep regular phone contact with student’s parent( s) and the community mental health provider to provide updates on how the student has been doing in school and what changes the parents and therapist are seeing in the community.
In the community:
A) Psychiatric consultation to review for the appropriateness of medication.
B) Family therapy (e.g., attachment-based family therapy). Access to 24-hour availability of crisis services/ hospital/ hotline.”
— Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (p. 99)
Assessing Level of Risk:
High Risk
“Youth at the highest risk
A) present frequent, intense, and enduring suicidal ideation.
B) They report specific plans, including choice of lethal means and availability/ accessibility of the method.
C) They will present with multiple risk factors and identify few if any protective factors.
This risk level requires the most interaction between various systems: parents, school professionals, the community, and mental health services outside of the school.
What to do:
A) Following the SRA, contact parents immediately.
B) Arrange with parents, law enforcement, or other professionals to transport the student to a hospital or outpatient community mental health agency responsible for evaluating youth for hospitalization. Some schools or districts may have a mobile support team available. This is another option to call where available.
C) Discuss the entire process with parents so they have a better understanding of what will occur at the hospital as well as what will happen if the student is hospitalized (e.g., homework, classes) and once he or she is reintegrated into school (see Chapter 7 for a discussion of re-entry).”
— Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (p. 99)
Assessing Level of Risk:
Low Risk
“Characteristics of youth at low risk for suicide:
A) Youth who report passing ideation that does not interfere with their activities of daily living,
B) no desire to die (i.e., intent),
C) no specific plan,
D) few risk factors,
E) and identifiable protective factors qualify as low risk for suicide.
(Both risk and protective factors are described in detail in Chapter 1.)
What to do: …
A) Notify parents.
B) Create a safety plan with youth and parents (unless parents are a trigger for suicide risk).
C) Identify school-based supports for youth. These could be a teacher, coach, or counselor but often will be support staff. Coordinate (with parents) to connect youth with community mental health services.”
— Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (p. 98)
Ideation
“Ideation refers to thoughts of killing oneself.”
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 106)
Intent
“Intent reflects the level of motivation and ability to follow through with a suicide plan.”
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 106)
Plan and Means
“Plan and Means describes when and how the person will kill him or herself.”
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 106)
Components of a Risk Assessment
“In order to keep the assessment manageable, Shea (2002) recommends a three-stage process for assessing suicide risk:
A) assessing risk and protective factors;
B) identifying suicidal ideation, intent, and plan;
C) and combining the information into a clinical, or risk, formulation."
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 102)
Concept of Imminent Risk
“According to Berman and Silverman (2013), the concept of imminent risk is the basis for all involuntary psychiatric commitment statutes. …
A) Real and present threat of substantial harm to self or others...
B) Likely to injure if not thwarted
C) Unable to care for self
D)...in the reasonable future
As the reader may note, these statutory provisions offer language that leaves the determination of imminent risk entirely up to the clinician’s best judgment applied to a subjectively determined timeline (i.e., some undefined number of hours into the future; e.g., 24, 48, 72 hours). Hence, imminent risk determinations are clinical and temporally related prediction of behavior in the near future (with no agreed-upon operational definition of what is meant by the near future). (Berman & Silverman, 2006, p. 4).”
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 96).
Assessing Level of Risk:
No Risk
“You can safely conclude that the student has no risk for suicide if, by the end of your SRA,
A) the youth reports no suicidal ideation, intent, or plan;
B) you have uncovered no evidence to contradict the student's statements (e.g., indicators from the student that he or she is misrepresenting suicide risk);
C) and there is no third-party information (e.g., reports from adults or documentation such as a suicide note) that presents evidence to the contrary."
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 97)
Risk Factor
“Risk factors refer to an individual’s characteristics, circumstances, history, and experiences that raise the statistical risk for suicide.”
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 12)
Warning Sign
“Warning signs are visible signs that a friend or loved one may show indicating that they may be in crisis and thinking about suicide.”
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 12)
Suicide Contagion
“Suicide contagion is described as imitative behavior where one death by suicide is a contributing factor to another suicide death (American Foundation for Suicide Prevention & Suicide Prevention Resource Center [AFSP & SPRC], 2011)…
A) Accounts for between 1% and 5% of all deaths by suicide annually
B) Can Lead to a suicide cluster
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 10)
Suicide Cluster
A suicide cluster “…is described as a group of suicides that have contributed to each other in some way.”
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 10)
Interpersonal Theory of Suicide (Thomas Joiner 2007):
Desire to Die
[Joiner’s] “…belief is that a desire to die is created by two of the risk factors listed below being experienced immensely for extended periods of time:
A) perceived burdensomeness and
B) a sense of low belongingness (Joiner, 2007).
When desire to die and capacity for suicide are both present, the scale may be tipped and a suicide attempt may occur.”
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 12)
Interpersonal Theory of Suicide (Thomas Joiner 2007):
Capacity for Suicide
“Joiner refers to capacity for suicide as an individual’s ability to kill themselves. As humans are biologically wired for self-preservation, they must develop the capacity for suicide whereupon they no longer fear pain, self-mutilation, or death.
...[E]ven if a student has warning signs, risk factors, and access to means, they become at risk for suicide only if a capacity for suicide is also present."
"When desire to die and capacity for suicide are both present, the scale may be tipped and a suicide attempt may occur."
– Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (pg. 11, 12)
